Provider Demographics
NPI:1740698067
Name:BRASCH, TARA (PT, DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BRASCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:DERUWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:370 E HERSEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2325
Mailing Address - Country:US
Mailing Address - Phone:541-482-6360
Mailing Address - Fax:
Practice Address - Street 1:370 E HERSEY ST STE 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2325
Practice Address - Country:US
Practice Address - Phone:541-482-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist